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Home My WebLink AboutMiscellaneous - 49 BREWSTER STREET 4/30/2018 (2) 496REWSTERSTREET 2101023.0-00640000.0 Date... NORTH 0 q TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSA mU I i7 This certifies that ./.�.��q.... has permission to perform ...6P ........ wiring in the building of.......... .... .............................. ...... . ....... North Andover,Mass. Fee...,5.T.7�'— Lic.No../. ............ . . IL�CrilC�UL'IiN�iC6MOPL Check # 35 10853 Commonweaa o� adaaChudetfa Official Use Only aL Je autment o D.7Fdu�e�erviced Permit No. 1 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK V All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: S- Z/—1Z_�aA City or Town of: rh y'06111W To the Inspector of Wires: By this application the undersigned gives otice of his or her intention to perform the electrical work described below. '-Location(Street&Number) 9 s ST \ Owner or Tenant Te _L4^-/ /(,IAA/1ci7s4 .� lephoneN - 6 o.g7�6�� Owner's Address i Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) _ Purpose of Building P g U ility Authorization No. 5:k(, 0/,Ffv� uri c�lr. Existing Service 200 Amps /Ld / 24/1)Volts Overhead( Undgrd❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 1 Completion of fliefibilowing table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o Emergency Lighting rnd. rnd. Batter Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and InitiatingDevices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump Number ons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW SecuritySystems:* • No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Si ns Ballasts No.of Devices or Equivalent No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: 2d00-- — (When required by municipal policy.) Work to Starts j-T_:?_/—/Z Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such overage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) /certify,under the s and penalties of erjury,that the information on this application is true and complete. FIRM NAME: Ay P,2 T /a LIC. NO.: 7//,p Licensee: Signatur LIC.NO.: (/(applicable ter "exempt"in the licens�smber ine.) Bus.Tel.No.:97X b5'1-5; 600 Address: P d• k 8 7 Alt.Tel. No.: *Per M.G.L.c. 147,s.57-61,security work requires D artment of Public Safety"S"License: Lie.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑ow is agent. Owner/Agent Signature Telephone No. PERMIT FEE. �.� � �L�� d� � _ �J 'L �� r Date . . . ....... .... '40 N -1 6 0 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION MUSEt This certifies that . . . . . . . . . . . . . . . . . . .. . has permission for gas installation . . .U-. Y. . . . . . . . . . . . . . . . . . . . . in the buildings of . . .k mi e-.J t. . . . . . . . . . . . . . . . . . . . . . .. . . . . at . . .L{ . . . . . . . . . . North Andover, Mass. Lic. No.. k�D .. . . . . Fee. I'NSP-ECTOA--� eAi Check 53u6 MASSACHUSETTS UNIFORMAPPUICATON FOR PEFAUTO DO GAS FrMNG Date (Type or print) D `b/J z 06 J NORTH ANDOVER,,,MASSACHUSETTS Building Locations / Permit# ^3 Amount$ )U P. Owner's Name 12-k New Renovation Replacement Plans Submitted FAIrak W O V F x C F F O C G0as p oG o !U- 44 r . 0 ir SUB•BASEM ENT B A S E M ENT 1ST. FLOOR 2ND. FLOOR r 3RD. FLOOR 4TH . FLOOR STH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR (Print or type) ,/� '�/ /.��2� � Ctte Lj one: Certificate Installing Company Name /lam �( Corp. Address S v d x _ Partner. Business Telephone 7 [o k-G n(3 Z�U / 071rndCo. Name of Licensed Plumber or Gas Fitter �,J L)fy� INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 13— No If you have checked yes,please indicate the type coverage by checking the appropriate box. ❑ Liability insurance policy 13---- Other type of indemnity 13 Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner 13 Agent 13 i hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts to Gas C e and Chapter 142 of the neral La Signature of Licensed Plu er Or Gas Fitter By: Title Plumber 42 3 City/Town � Gas Fitter [cense Number 0-�Iaster PROVED(OFRCE USE ONLY) 0 Journeyman Location No. Date A2 NORTH TOWN OF NORTH ANDOVER O w s t • � ; � Certificate of Occupancy $ • � _ •a ;�s'•^°Eta Building/Frame Permit Fee $ wcNus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # AIP 18660 Building inspecjorf TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING ` �.Tlti� tioa for t?ft"iclt>;1�7ee Onl � � BUILDING PERMIT NUMBER: � j� DATE ISSUED: SIGNATURE: ic Building Commissioner/I6 ntor of Bui I Idings Date SECTION i-SITE INFORMATION z 1.1 Property Address: 1.2 Assessors Map and Parcel Number: O 023 , - 6 w6g- O , A/1,r (1 D I1//&R Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Fronts fl 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Recliulired Provided 1.7 Water Supply M.G.L.C.40.§54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: � Public ❑ Private ❑ Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System ❑ > SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record c Y oNod Z c1�,Ek' LITF�1sT i2 sT Name(Print) Address for Service Signature Telephone r 2.2 Owner of Record: Name Print Address for Service; O Z Signature Tele hone M SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: O License Number Address an Signature Telephone Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ 1��9Vt��ST Zo�� R F6. �- �C��.0 � Company Name alb [,,,( � Registration Number �U=Q Er SU,L F ZZZ —J �` �'3 �•V Expiration /�L/6 6 SEVEN L�inature Tele hone SECTION 4-WORKERS COMPENSATION(M.G.L.C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......0 No.......❑ SECTION 5 Description of Proposed Work(check-all applicable) New Construction ❑ Existing Building Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify 1 Brief Description of Proposed Work: VM1 rI- s iID 61-- SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OMCIAIG USE.ONI Y . C leted by permit applicant ' r to 1. Building / (a) Building Permit Fee !b d Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)x tbl 4 Mechanical(HVAC) 5 Fire Protection d 6 Total 1+2+3+4+5) Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT L as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. f Signature of Owner Date SECTION')7b OWNER/AUTHORIZED AGENT DECLARATION 1> V 1Z C-6 S rR tp/y E as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief VAVID cs Print 'ani I Si nature of Owmer A ent Date iql NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TEVMERS iST2ND 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHRANEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE ! � NOlRT►y Town of " Andover i0 C- L A /+. dover, Mass., �✓ �� T O C OC MICCFIE WICK � 7�ADRATED Jk? �`S E BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.... .......... .......... ...... ........................................................;............. Foundation . ........... ddin has permission to erect............................ gs on..��. .... Rough to be occupied a • Chimney provided that the person ep ing this permit s all in eve sped conform to the terms of the application on file in Final this office, and to the pr ions of the Codes and By-Law elating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO Rough ......................................................... ................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. IFSEE REVERSE SIDE Smoke Det. F-.w� i6 `Che Commonwea th of%assachusetts _ I Departn=t of 1nd=tria1-1GL7dents Office of Investigations 600 Washington Street Boston, Xq 02111. Workers'CompensationInsurance.Sfridavit APPLICANT 17\1FORALMON Please PRINT L-Qibly,. Name: Location: .51 R >c City: o, Telephone#:___I I am a homeowner performing all work myself. O I am sole proprietor and have no one worldne in my capacity 0 I am an employer providing workers'co�mjpensation for my employees working on this Job. Company Name: �+ (� ri UA G DO U J C Address: ��0 sU n � �` Vl1Jtt 01ale City: Telephone#: g 7 P 6 B 8t34;ZO Insurance Company: �. _ Policy#: VW C 104 O Q g go I OLo d v u I am(circle one) sole proprietor,general contractor or homeowner and have hired the contractors listed below who have the following workers' compensation policies: Company Name: Address: City: Telephone#: Insurance Company: Policy#: i Company Name: Address: City: Telephone#: Insurance Company: Policy#,: Attach additional sheet if necessary ailure to secure coverage as required under Section 25A of MGL 15B can lead to the imposition of criminal penalties of a rine up to$1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a.fine of X100.00 a day against understand that a copy of this statement may be forwarded to the Office of investigations of the DIA for coverage verification, I do herebyc •. under t pains an enalties of perjury that the information above is true and correct i Siffiature: ` Date: Print Name: � J ftiC04 e. Phone# %7 6 (I 6 3 ,34,-�)-o i I Official Use ONLY.Do not write in this area City or Town: o Building Department PermiULicense, o Licensing Board o Selectmen's Orrice ❑Check if Immediate response is required o Health Department 0 Other Dq-FORNUTION &iNST)E UCTIONS Massachusetts General Laws chapter 152 section'25 requires all employers to provide workers' compensation for their employees. As quoted from the"law"an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. .An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal,entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a:license or permit to operate a business of to construct buildings in,the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of,its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the.box that applies to your situation and supplying company names,address and phone numbers as all affidavits may be submitted to the. Department of Industrial Accidents for.confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the.permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the "law" or if you are required to obtain a workers'.compensation policy,please call the Department at the number listed below. city or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions; please do not hesitate to give us a call, The Department-'s address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, ISA 02111 Fax#(617) 727-7749 Telephone (617) 727-4900 ext. 406,409, or 375 Board of Sodding Regulations and Standards : - HOME IMPROVEMENT CONTRACTOR Registration:. 104569 Expltation ,7/1412006 Type: Private Corporation p. DAVID CASTRICO.Ng ROOFING ODING& David Castricone 7 Hillside Road 8Word,MA 01921 Administrator NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54,a condition of Building Permit at: is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. Also,.note Permits are required under Fire Prevention laws Chapter 148 Section 10A. The debris will be disposed of in: of Facility) (q9-tekEIJs� )(Location , Signature of Permit Applicant Fire Department Sign off: � Dumpster Permit 26 1,2-j Date